Voiding Difficulty

What is Voiding Difficulty?

When a woman finds that her passing of urine has become abnormally slow and intermittent (stopping and starting) or she feels that she has not completely relieved her urine after each void

It may begin suddenly or develop gradually

It is usually accompanied by lower abdominal pain or it may be painless

It may progress to the patient being unable to pass urine completely (acute retention of urine) resulting in the bladder becoming over distended (over stretched) and the retained urine overflows out (giving rise to overflow incontinence of urine)

Why is Voiding Difficulty important?

It is important to diagnose it early to prevent acute retention of urine and the bladder from sustaining over-stretch injury that may have the long term consequence of chronic retention of urine. The larger the amount of urine retained in the bladder and the longer the retention persists, the longer it will take for the bladder to recover.

What are the causes?

Most of the difficulty in voiding arises from obstruction of the urethra (urine pipe), such as:

Complication of surgery for stress incontinence of urine or pelvic organ prolapse

After a prolonged labour, especially with epidural for pain relief, difficult vaginal or instrumental delivery with episiotomy (cut) or tears, piles and pain

End of first trimester of pregnancy (12-13 weeks) with a retroverted uterus (womb that is tilted backwards) causing the cervix (mouth of the womb) to push forwards onto the urethra (urine pipe) or bladder neck obstructing it

Uterine fibroid/s situated in the back wall of the womb causing the same effect as just mentioned above

Side effects of medications

Constipation

Bladder disorders due to neurological disease or chronic over-distension may also cause voiding difficulty.

Women with psychological impairment due to anxiety and depression may likewise present with these urinary problems.